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  • In fatal cases, the most prominent viagra generico vendita online findings reported by Zimmerman and Ishak consisted of microvesicular steatosis together with zone 2 necrosis (51). VPA has been reported to unmask latent heterozygous phenotypes of ornithine transcarbamylase deficiency leading to fatal hyperammonemic coma (59,70). On the other hand, indicators of synthetic function, such as the prothrombin time and accompanying impairment of coagulation, likely provide more accurate assessment of residual hepatic function. Elevated ammonia levels are also present but are also observed in the absence of other indicators of compromised hepatic function. Measures of hepatic function such as AST, ALT, and bilirubin may exceed three times the upper limit of normal in VPA-treated patients although fatal hepatotoxicity actually occurs in only a small number of individuals.

    B. In fatal cases, high serum transaminase and bilirubin levels represent the consequences of extensive hepatocellular damage rather than being specific markers of VPA-associated hepatotoxicity. Pathology The histopathology of VPA hepatotoxicity differs substantially from that associated with the aromatic anticonvulsants phenytoin, phenobarbital, and CBZ in that signs of immune involvement and eosinophilia are not present.

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